Perceived Racism, Discrimination and the Prenatal Care Experiences of Women in Connecticut

Background & Purpose:

Racial and ethnic disparities pervade birth outcomes both in the United States, and in Connecticut. In 2009, while Connecticut’s infant mortality rate was less than that of the U.S., rates for Connecticut’s non-Hispanic Black/African American and Hispanic/Latino communities exceeded the national average. 

In an effort to improve birth outcomes, the objective of this study was to explore how prenatal care in Connecticut may be enhanced.  Specific research questions included: 

• What are women’s interpersonal experiences with their prenatal care? 
• Are these women knowledgeable about pregnancy-related risk and protective factors?
• How do racism and/or discrimination affect these women’s prenatal care experiences?

Methods:

Seven focus groups (n=45) and two semi-structured interviews (n=2) were conducted in the spring of 2013. One focus group was conducted in Spanish (n=6).  A brief survey was also administered to each participant to assess pregnancy status, number of existing children, demographics, perceived knowledge of risk and protective factors for preterm birth, and a measure of interpersonal processes of care. 

Convenience sampling was used.  Participants were referred to the study via local social service providers.  All 47 participants were age 18 or older and either currently pregnant and/or within one year post-partum with their youngest child.  The majority of participants identified as non-white (n=43). 

Focus group and interview recordings were transcribed verbatim and uploaded into NVivo 10 for thematic analyses.  Coding was triangulated amongst three researchers.  Survey data was entered into SPSS version 21 and analyzed using descriptive statistics. 

 Results

Participants were overall, satisfied with their prenatal care.  While most did not endorse outright barriers to care, they did acknowledge challenges, many of which could be addressed by changing agency policies and/or procedures.  Most participants reported that they knew the protective and risk factors, except almost half did not know that the lack of folic acid before pregnancy (n=21) and fertility treatments (n=25) were risk factors for pre-term birth. 

The qualitative themes include: 

1. The women prioritized their prenatal care.
2. They were more satisfied with their treatment from providers than with office staff. 
3. Participants generally preferred private doctor’s offices to hospital clinics or community health centers. 
4. The primary challenges to care involved money, insurance and social services, transportation, and access to healthy food. 
5. Participants experienced a lack of patient-centered care.
6. Although not directly related to their prenatal care, the women’s narratives featured experiences of considerable discrimination and trauma in their lives.

Conclusions & Implications

Findings suggest that while women highly esteem their providers’ clinical advice, they also feel unheard in their prenatal care experiences and face structural challenges to accessing care.  Moreover, women’s reports of discrimination and trauma across the lifespan heighten the need for a trauma-informed approach to prenatal care.  This study emphasizes the need to train health care organizations in cultural competency, structural competency, and organizational cultural competence, as well as trauma-informed care.  With our person-in-environment perspective, micro and macro approaches, and interdisciplinary strengths, social workers are well positioned to lead this work.